Resident 5 told inspectors during a September 29 interview that the facility often operated with just two nurse aides covering the entire building during day and evening shifts, particularly on weekends. The resident said this forced difficult choices between waiting for assistance or getting up unassisted, despite feeling unsafe doing so.
"The resident felt unsafe, however didn't want to be incontinent," inspectors wrote.
The resident had been promised twice-weekly baths upon admission last spring, but that schedule lasted only about two weeks. By the time of the inspection, the resident hadn't bathed in two weeks and rarely received the promised two baths per week.
A family member had raised concerns about the bathing schedule over several months, telling administrators they felt reassured their complaints were being addressed but saw no significant changes. The relative noted that despite promises of twice-weekly baths, "nothing had changed significantly."
Resident 5 praised the nurse aides as "very kind and caring" workers who "work very hard," but said having two people cover four halls wasn't sufficient staffing. When the resident complained to administration about the staffing levels, administrators insisted they had enough help.
The resident "felt they were not receiving the services paid for" and said the understaffing problems had persisted since admission to the facility last spring.
The facility's Director of Nursing confirmed the resident's concerns during her own interview with inspectors on September 29. She acknowledged that with the current census of 35 residents, the facility was not meeting needed nurse aide staffing levels.
The DON outlined the actual staffing pattern: three nurse aides during day shift, plus an additional aide for bathing up to five days a week for eight hours daily. Evening shift had 2.5 nurse aides, and night shift had two. This totaled 60 hours of nurse aide coverage over 24 hours, plus the eight-hour bath aide.
She compared this to staffing for a smaller census of 27 residents, which would include two nurse aides on day shift plus the bathing aide, two on evening shift, and two at night. That would total 46 nurse aide hours plus eight hours of bathing assistance over 24 hours.
The staffing shortage particularly affected response times to call lights. Resident 5 reported waiting 20 to 30 minutes for assistance after activating the call system, creating situations where the resident felt compelled to attempt unsafe transfers rather than risk incontinence.
The inspection found that residents were experiencing "minimal harm or potential for actual harm" due to the staffing deficiencies, with few residents affected by the violation.
Good Samaritan Society - Bloomfield, located at 300 North Second Street, operates as part of the larger Good Samaritan Society network. The facility's acknowledgment that it wasn't meeting needed staffing levels came after months of resident and family complaints about delayed care and missed services.
The DON's admission during the inspection contradicted the administration's previous responses to resident complaints. While administrators had repeatedly told Resident 5 that staffing was adequate, the facility's own nursing director confirmed to federal inspectors that coverage fell short of requirements.
The resident's experience highlighted the daily impact of insufficient staffing on care quality. Beyond the extended waits for assistance and irregular bathing schedule, the situation forced residents to make unsafe choices about their own mobility rather than wait for help that might not come promptly.
Federal inspectors documented the violation under regulations requiring facilities to provide sufficient nursing staff to meet residents' needs for care and services. The inspection was conducted in response to complaints about the facility's operations.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Good Samaritan Society - Bloomfield from 2025-11-18 including all violations, facility responses, and corrective action plans.
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